New urgency surrounding children and coronavirus

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CDC adds 6 new possible coronavirus symptoms - Axios

Solving the mystery of how the coronavirus impacts children has gained sudden steam, as doctors try to determine if there’s a link between COVID-19 and kids with a severe inflammatory illness, and researchers try to pin down their contagiousness before schools reopen.

Driving the news: New York state’s health department is investigating 100 cases of the illness in children, Gov. Andrew Cuomo said at a Tuesday press briefing, Axios’ Orion Rummler reports.

  • Three children in the state have died: an 18-year-old girl, a 5-year-old boy, and a 7-year-old boy. The state’s hospitals had previously reported 85 cases on Sunday.

Doctors have described children “screaming from stomach pain” while hospitalized for shock, Jane Newburger of Boston Children’s Hospital told the Washington Post.

  • In some, arteries in their hearts swelled, similar to Kawasaki disease, a rare condition most often seen in infants and small children that causes blood vessel inflammation, she said.
  • Researchers remain uncertain if this is being caused by COVID-19, but most children appear to have a link. Some affected children have tested positive for coronavirus antibodies, suggesting that the inflammation is “delayed,” Nancy Fliesler of Boston Children’s Hospital wrote on Friday.

What’s next: The CDC is funding a $2.1 million study of 800 children who have been hospitalized after testing positive for the coronavirus through Boston Children’s Hospital. The study aims to understand why some children are more vulnerable to the disease.

 

 

 

 

Schools are essential. Don’t rule them out.

Schools are essential. Don’t rule them out.

Teach Your Children Well - Crosby Stills Nash and Young (Ukulele ...

It remains to be seen just how much President Trump’s extension of social distancing guidelines in the United States until April 30 defers the debate over when to safely restart the economy, allowing policymakers to focus on how to ramp up the testing and PPE availability to do so. When the time comes, they also need to contemplate the question asked by Aaron Carroll in the March 17th New York Times, “Is closing the schools a good idea?”

The question was not rhetorical. It cited the food insecurity addressed by school lunch and breakfast programs as well as the physical safety provided, particularly for homeless children. While New York City schools are providing 3 meals/day for children who need, child protective services in many regions are already seeing 50% declines in reporting of child abuse and neglect. With families stressed economically and confined to home without supervision, that is not good news since neglected or abused children are often only identified at school. In this week’s New Yorker Peter Hessler writes anecdotally about 2 suicides in youth attributed to the lockdown in China, matching that country’s total number of pediatric deaths thus far due to SARS-CoV-2 in the literature.

When we think of flattening the curve to protect the most vulnerable in society, our minds jump to the very old and the very young. Evidence from previous influenza pandemics supports our instincts. But SARS-CoV-2 appears different. Not only has critical illness in children in China and Italy been extremely rare, in both countries children make up only 1% all cases.

Even in New York state, where younger age groups seem to have been hit harder than in Italy, children still only represent 2% of cases. Finally, in a country like Iceland, which has tested a large proportion of its population, including many without any symptoms at all, children under 10 years old make up only 2% of the cases. It is these numbers that beg examination of one of Dr. Fauci’s hypotheses in the New England Journal of Medicine – that “children are less likely to become infected.”

The first SARS-CoV pandemic in 2002-2003 documented 135 pediatric cases, or only 1.7% of the 8098 reported worldwide to the World Health Organization (WHO) by the time it was declared contained, with no deaths and only 1 reported case of transmission of the virus from a pediatric patient. The WHO January 2020 Situation Update for the Middle East respiratory syndrome (MERS), another coronavirus, shows children and adolescents to be similarly disproportionally unaffected. A Japanese study of transmission in close contacts of known positive coronavirus 2019 (COVID-19) patients demonstrated a much lower attack rate amongst children than adults.

And according to the Report of the WHO-China Joint Mission on COVID-19, no one performing case tracing on the ground in China could “recall episodes in which transmission occurred from a child to an adult.”

Singapore has been lauded for its ability to mitigate the COVID-19 outbreak. Its rigorous implementation of control measures has included opening (and re-closing, next on April 8th) schools concurrently with other activities. Perhaps, as speculated by Dr. Dale Fisher, an infectious diseases specialist from Singapore who served as a member of the WHO-China Joint Mission, “children… don’t amplify the transmission. They are kind of bystanders while it goes on.”

If true, schools should be among the first US institutions re-opened, not the last. They are at least as essential as liquor stores and gun shops.

 

 

 

MARTIN LUTHER KING JR.’S HEALTHCARE JUSTICE ADVOCACY MAKES AMERICA’S HOSPITALS BETTER TODAY

Martin Luther King Jr.’s Healthcare Justice Advocacy Makes America’s Hospitals Better Today

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Every January, the United States celebrates the lasting legacy of Dr. Martin Luther King Jr. Not widely known is how his civil rights advocacy made a lasting impact on modern-day hospitals, including children’s hospitals.

Today in 170 Children’s Miracle Network Hospitals, every young patient is treated regardless of their race or background. CMN Hospitals are deeply committed to offering world-renowned treatment to all kids in need and that’s why donations to your local hospital can make such a difference for families facing health crises.

Unfortunately, certain hospitals in America were still segregated in the not too recent past. When Brown vs. Board of Education passed in 1954, schools began to desegregate, and this paved the way for institutions like hospitals to follow suite. King’s healthcare justice advocacy advanced health care access in particular for the African American community.

A History of Unequal Healthcare

When patients enter a hospital, they expect to receive a standard of care that will improve their lives regardless of who they might be. That expectation, unfortunately, has not always been backed up by medical institutions across the United States. African Americans, in particular, experienced a history of receiving substandard care and outright abuse within the framework of medical science.

Notable examples of this include:

While the details of those specific examples weren’t publicly known in the 1960s, African Americans were certainly aware that they received care that was inferior to white patients. Doctors and hospitals continued perpetuating this double standard even after the passage of the Civil Rights Act in 1964. The disparity in treatment quality was so egregious that Dr. Martin Luther King Jr. spoke out against it, calling for an awakening in the conscience of the United States.

Desegregating Hospitals

King uttered his famous words on healthcare while addressing the press before attending the annual meeting of the Medical Committee for Human Rights, an organization formed because the American Medical Association was segregated at the time. “Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death,” said King.

The Civil Rights Act of 1964 isn’t typically associated with healthcare. However, at that point in history, it was well known that some hospitals and medical institutions were resisting the push for desegregation, a practice which hospitals used to provide less than adequate care to African American patients. Hospitals would continue to hold onto such discriminatory practices unless something was done.

Legal Gains for Equality in Hospitals

The reason King spoke out so vehemently in 1966 was due to the passage of Medicare and Medicaid in 1965, something that was only possible due to the efforts of the Medical Committee for Human Rights and its head, W. Montague Cobb. The organization made use of the non-violent protest strategies of King and the Civil Rights Movement. The passage of the Social Security Act, which created Medicare and Medicaid brought federal funding into every hospital and medical institution in the United States, forever binding each facility to the Civil Rights Act, a stipulation of which was that any organization receiving federal funding could not discriminate on the basis of race.

From that point onward, hospitals that clung to the old ways of discrimination were subject to lawsuits from mistreated African Americans and pressure from activists like King and the Medical Committee for Human Rights. This gave King the legal ground to stand on when calling on hospitals to abandon the evil practice of systemic discrimination in 1966 with those now famous words from that 1966 conference.

While we know there’s more work to be done to promote equal healthcare access to every child in need across North America, we’re proud that our non-profit children’s hospitals can be a part of the solution.

Thank you, King.

 

 

 

 

Number of Uninsured Children Increases by 400,000

https://www.thefiscaltimes.com/2019/10/30/Number-Uninsured-Children-Increases-400000

A new report from the Georgetown University Health Policy Institute says the number of uninsured children in the U.S. increased by more than 400,000 between 2016 and 2018.

Some key findings from the report:

  • The number of uninsured children rose above 4 million by the end of 2018.
  • Insurance coverage losses are concentrated in 15 states — Alabama, Arizona, Florida, Georgia,
  • Idaho, Illinois, Indiana, Missouri, Montana, North Carolina, Ohio, Tennessee, Texas, Utah, West Virginia.
  • States that have not expanded Medicaid, as allowed by the Affordable Care Act, have seen much larger increases in uninsured rates.
  • Children in non-expansion states are nearly twice as likely to be uninsured compared to states that have expanded Medicaid.
  • White and Latino children saw the largest increases in the uninsured rate.
  • Households with low to moderate income – $29,000 to $53,000 per year for a family of three – were the hardest hit.

The report’s authors said it’s no coincidence that the increases in the number of uninsured children have occurred since President Trump took office in 2017.

“This serious erosion of child health coverage is likely due in large part to the Trump Administration’s actions that have made health coverage harder to access and have deterred families from enrolling their eligible children in Medicaid and CHIP,” they wrote in their conclusion. “These actions include attempting to repeal the ACA and deeply cut Medicaid, cutting outreach and advertising funds, encouraging states to put up more red tape barriers that make it harder for families to enroll or renew their eligible children in Medicaid or CHIP (or ignoring it when they do), eliminating the ACA’s individual mandate penalty, and creating a pervasive climate of fear and confusion for immigrant families.”

 

 

 

 

CFO of Children’s Health in Dallas steps down; 2nd finance leader to leave in a month

https://www.beckershospitalreview.com/hospital-executive-moves/cfo-of-children-s-health-in-dallas-steps-down-2nd-finance-leader-to-leave-in-a-month.html?origin=cfoe&utm_source=cfoe

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Rich Goode, vice president and CFO of Dallas-based Children’s Health, resigned Sept. 24, about a month after another finance leader left the organization, according to The Dallas Morning News.

Hospital officials did not give a reason for his departure. The organization has not responded to Becker’s request for comment.

Mr. Goode’s resignation comes after the August departure of Ryan Bailey, head of investments at Children’s Health, who left to form an investment firm.

Mr. Goode served as CFO for three years, joining Children’s Health in 2016. He was previously vice president of finance and CFO at Cook Children’s Health Care System in Fort Worth, Texas.

Mr. Goode is credited with doubling the system’s net operating income and implementing analysis tools to offer better insights into its financial health during his tenure.

 

Federal appeals court limits hospitals’ disproportionate-share funding

https://www.modernhealthcare.com/payment/federal-appeals-court-limits-hospitals-disproportionate-share-funding?utm_source=modern-healthcare-daily-finance-wednesday&utm_medium=email&utm_campaign=20190814&utm_content=article1-headline

Hospitals that care for a large share of Medicaid, low-income and uninsured patients stand to receive less funding from the federal government after the D.C. Circuit reconsidered how Medicaid disproportionate-share hospital reimbursement is calculated.

A three-judge panel of the U.S. Court of Appeals for the District of Columbia Circuit reversed a lower court and reinstated a 2017 rule establishing that payments by Medicare and private insurers are to be included in calculating a hospital’s DSH limit, ultimately lowering its maximum reimbursement.

In Tuesday’s ruling, U.S. Circuit Judge Karen LeCraft Henderson opined that the rule aligns with the intent of the Medicaid Act.

“By requiring the inclusion of payments by Medicare and private insurers, the 2017 rule ensures that DSH payments will go to hospitals that have been compensated least and are thus most in need,” Henderson wrote.

The case, brought by four children’s hospitals in Minnesota, Virginia and Washington and an association representing eight children’s hospitals in Texas, concerns the calculation of the uncompensated costs of treating Medicaid beneficiaries known as the “Medicaid shortfall.

For instance, if a hospital spends $1 million on treating Medicaid patients who have no other healthcare coverage and Medicaid pays $600,000, then the Medicaid shortfall is $400,000. In some instances, Medicaid patients have additional third-party coverage such as Medicare or private insurance.

Hospitals cannot receive more money in Medicaid DSH payments than they spent to treat Medicaid beneficiaries or the uninsured. Part of the motivation behind that stipulation was to prevent hospitals from double dipping by collecting DSH payments to cover costs that had already been reimbursed. Previous cases also revealed that some states have made DSH payments to state psychiatric or university hospitals that exceed the net costs, or even total costs, of operating the facilities.

Providers successfully fought the 2017 rule that limited hospitals’ reimbursement. A federal judge sided with the hospitals that claimed the CMS overstepped its authority and essentially ignored payments by commercial insurers and Medicare. That was overturned Tuesday.

The Children’s Hospital Association of Texas said in a statement that it is exploring its options.

“We are disappointed with the result because it will reduce critical Medicaid funding to safety net providers like children’s hospitals,” the association said. “These hospitals are heavily reliant on Medicaid payments because between 50% and 80% of their inpatient days are covered by Medicaid. Children’s hospitals care for all children, and are, in fact, often the only place that children with complex conditions can get life-saving care.”

 

 

 

Why Are at So Many Children Losing Medicaid/CHIP Coverage?

Why Are at So Many Children Losing Medicaid/CHIP Coverage?

Along with the American Academy of Pediatrics, First Focus and Children’s Defense Fund, Georgetown University CCF held a press tele-conference and released a report examining an alarming trend in children’s health coverage. The report shows that more 800,000 fewer children had Medicaid/CHIP coverage at the end of 2018 compared to 2017. This trend comes amid broader efforts to restrict access to health coverage and discourage participation by legal immigrants.

The report found little evidence to support claims that the improving economy was responsible for the 2.2 percent decline in enrollment. Instead data suggest this 2018 could be the second year in a row that the rate of uninsured children increases. The U.S. Census Bureau will release the 2018 child uninsured rate data later in the fall.

Enrollment declines are concentrated in seven states – California, Florida, Illinois, Missouri, Ohio, Tennessee, and Texas – which account for nearly 70 percent of the losses. Nine states – Idaho, Illinois, Maine, Mississippi, Missouri, Ohio, Tennessee, Utah, and Wyoming – had decreases of more than double the national average.

Please listen to the recording of the press call or read the report for more details. Here a few excerpts from Thursday’s press conference:

Joan Alker of CCF moderated the call and explained why this drop in child enrollment is so alarming.

“We are extremely concerned about what we are seeing and what it portends for the uninsured numbers these fall,” she said. “For many years there’s been a national bipartisan commitment to reduce the number of uninsured children and the effort have borne fruit. Unfortunately, today we do not feel confident that this national commitment still exists.”

Tricia Brooks, lead author of the report, explained the many factors have likely led to the decline in child enrollment.

“Knowing that the economy had a minimal impact at best, we must call on state and national policymakers to address the factors contributing to the enrollment decline,” said Brooks. “From systems and renewal issues to enrollment barriers to threats like public charge, we must take a hard look at what these administrative actions and barriers to coverage mean for our kids’ health.”

Dr. Laura Guerra-Cardus, Deputy Director for the Children’s Defense Fund of Texas  said overly cumbersome eligibility checks are causing thousands of eligible children to lose coverage in her state. Nine out of every 10 Texas children being dropped are losing coverage due to red-tape. She said this is causing significant confusion for families and throughout the Texas health care system as many families don’t learn their children are uninsured until they show up for an appointment with their health care provider.

“These income checks are erroneously flagging families – at the very least 30% of the time. Families are not being given enough time to respond,” she said. “They are given only ten days to respond and the timeline starts once flagged by the system which could be before the parents even receive notification.”

Bruce Lesley, President of First Focus, pointed out that bipartisan legislation in the U.S. Congress would address the issues raised by Dr. Guerra by requiring 12 months continuous health coverage for children. He also cited polls that show strong support for children’s health coverage in general.

“The American public is with us on this. Kids are a priority but we’re seeing a failure of policymakers to adhere to what voters want and make children a priority,” Lesley said.

Dr. Lanre Falusi, a pediatrician at the Children’s National Health System and national spokesperson for the American Academy of Pediatrics said pediatricians are very concerned about the decline in Medicaid and CHIP enrollment. In addition to cumbersome enrollment process and administrative burdens discouraging families from enrolling eligible children, she pointed out that immigrant families also encounter the chilling effect the proposed public charge rule.

“The public charge proposal presents immigrant families with an impossible choice: keep your family healthy but risk being separated or forgo vital services like Medicaid so your family can remain together in this country. Although the final rule has yet to be issued, the proposal has already caused immigrant families to avoid or even disenroll from programs they are eligible for out of fear, like Medicaid. I have seen this myself,” Dr. Falusi said.

“We need all children in the United States to reach their full potential if we are to reach ours as a nation. Ensuring children are enrolled in health coverage designed to meet their needs is necessary to making that possible. Our lawmakers must pass policies that keep programs like Medicaid and CHIP strong, not those that jeopardize the critical gains we’ve made in children’s coverage.”